| Organization Name: | BLACKHAWK MANGUM LLC |
| NPI Number: | 1104008168 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAYNA HEINE (INSURANCE CREDENTIALING SUPERVISOR) |
| Mailing Address: | One Wickersham Drive Mangum |
| State: | OK US |
| Postal Code: | 73554 |
| Phone Number: | 5807823353 |
| Fax Number: | |
| NPI Enumeration Date: | 12/03/2007 |
| NPI Last Update Date: | 11/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 275N00000X |
| License Number: | 2208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Medicare Defined Swing Bed Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |